Lactation and Breastfeeding

Lactation Physiology - Milk Miracles

• Hormonal Control:
  • Prolactin (Ant. Pituitary): Milk synthesis (Lactogenesis II). ↑ with suckling.
  • Oxytocin (Post. Pituitary): Milk ejection (let-down reflex); myoepithelial cell contraction. Stimulated by suckling.
• Stages of Lactation:
  • Mammogenesis: Breast development (estrogen, progesterone, prolactin).
  • Lactogenesis I: Mid-pregnancy; colostrum production; high progesterone inhibits full lactation.
  • Lactogenesis II: Postpartum (day 2-3); ↓ progesterone → copious milk ("milk coming in").
  • Galactokinesis: Maintenance via suckling & milk removal.
  • Involution: Weaning → ↓ prolactin → milk cessation.
• Key Reflexes:
  • Suckling Reflex: Stimulates prolactin & oxytocin.
  • Let-down Reflex: Oxytocin-mediated milk ejection.

⭐ Prolactin is essential for milk synthesis, whereas oxytocin triggers milk ejection.

Breast Milk Composition - Nutrient Nectar

• Energy: ~65-70 kcal/100ml.
• Types & Key Changes:
  • Colostrum (first 3-4 days): ↑Protein, ↑IgA, ↑Vitamin A, ↓Fat, ↓Lactose. "Liquid Gold".
  • Mature Milk: ↑Fat, ↑Lactose.
• Macronutrients (Mature Milk):
  • Carbohydrates: Lactose (main sugar, aids Ca absorption).
  • Proteins (0.9-1.1 g/dL): Whey:Casein ratio changes from 90:10 (colostrum) to 60:40 (mature). Key: α-lactalbumin, lactoferrin.
  • Fats (3.5-4.0 g/dL): Triglycerides; essential fatty acids (DHA, ARA) for neurodevelopment.
• Key Immunological Factors:
  • Secretory IgA (sIgA), Lactoferrin, Lysozyme, Macrophages, Lymphocytes.
  • Human Milk Oligosaccharides (HMOs) - prebiotics.
• Vitamins & Minerals:
  • Low: Vitamin D, Vitamin K (prophylaxis needed for Vit K at birth; Vit D supplementation for baby).
  • Iron: Low quantity, but high bioavailability (~50% vs. ~10% from formula).

⭐ Whey protein in human milk is more easily digestible than casein, contributing to softer stools and less GIT upset in breastfed infants compared to formula-fed infants. Human milk's whey:casein ratio is initially high (e.g., 80:20 or 70:30) and transitions to about 60:40 in mature milk, whereas cow's milk is about 20:80 (casein-dominant).

Breastfeeding Techniques - Latch & Love

• Good Latch (C.H.I.N.S. Mnemonic 📌):
  • Chin touches breast.
  • Head free, slight extension.
  • Inverted lower lip (flanged).
  • Nose clear.
  • Support breast (C/U-hold).
  • Mouth wide; large areola in mouth (more seen above than below).
  • Painless; rhythmic suck/swallow.
• Positioning:
  • Mother comfortable; baby aligned (ear-shoulder-hip straight line).
  • Common Holds: Cradle, Cross-cradle, Football (clutch), Side-lying.
• Feeding Cues & Frequency:
  • Early cues: Rooting, sucking motions, hand-to-mouth. (Crying: late sign).
  • Feed on demand: Typically 8-12 times in 24 hours.
• "Love" - Bonding & Benefits:
  • Skin-to-skin contact: Promotes bonding, regulates baby's vitals.
  • Oxytocin release: ↑Maternal-infant bond, aids milk ejection (let-down).

⭐ Asymmetrical latch is crucial: baby's nose to nipple, ensuring more areola is taken with the lower lip for effective milk transfer and nipple comfort.

Breastfeeding Challenges - Problem Solvers

• Sore/Cracked Nipples:
  • Cause: Poor latch.
  • Tx: Latch correction, lanolin, air dry. EBM application.
• Engorgement: (Day 2-5 postpartum)
  • Cause: Milk stasis.
  • Tx: Frequent feeds/pump, warm compress (before), cold (after). Reverse pressure softening.
• Plugged Ducts:
  • Tx: Warm compress, massage, frequent feeds, vary positions.
• Mastitis: (Unilateral, tender, red, warm breast; fever)
  • Tx: Continue BF/pump. Analgesics. Antibiotics (Dicloxacillin 500mg QID x 10-14d).

  ⭐ Most common cause of infective mastitis is Staphylococcus aureus.

• Nipple Candidiasis: (Burning pain, itchy, shiny nipple)
  • Tx: Antifungals (mother & baby, e.g., miconazole, nystatin).
• Insufficient Milk Supply (IMS):
  • Tx: Effective latch, frequent emptying. Galactagogues (guided). Hydration, nutrition.

High‑Yield Points - ⚡ Biggest Takeaways

• Prolactin (anterior pituitary) for milk production; Oxytocin (posterior pituitary) for milk ejection.
• Colostrum (first 3-4 days): rich in IgA, protein, and growth factors.
• Exclusive breastfeeding: recommended for first 6 months; continue up to 2 years.
• Key contraindications: Infant galactosemia, maternal HIV, active TB.
• Mastitis: commonly S. aureus; treat with antibiotics, continue breastfeeding.
• Vitamin K at birth for all; Vitamin D supplementation for breastfed infants.